Care Management Matters December 2020

DECEMBER 2020

www.caremanagementmatters.co.uk

TAKING CARE OF YOU The science to good mental health

Off target?

CQC’s new Right support guidance

Steps to a sale

How to prepare your business

Tech in 2021

What can we expect?

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In this issue 05

Inside CQC Debbie Ivanova, Deputy Chief Inspector of Adult Social Care, offers her insights into the Out of sight – who cares? report.

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CMM News

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Into Perspective This month, we look at the question of social care reform. Will it happen, and will it be worth the wait?

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Celebrating Excellence The Markel 3rd Sector Care Awards judging day took place virtually this year. Find out which finalists have been selected across the 12 categories.

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Event Review We share the future that was envisioned by those in the industry who want to see change at Social Care Future’s online festival.

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Straight Talk Caroline Waters OBE explains why now is the time for us to show we care about those living in care.

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REGULARS

From the Editor

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FEATURES

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Right support, right care, right culture: Have they got it wrong?

Neil Grant, Partner at Gordons Partnership LLP, asks, has the regualtor missed the mark with the publication of its new statutory guidance for the learning disability and autism sector?

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Calling for a better future for social care Care Provider Alliance (CPA) is calling for a long-term funding solution, and better conditions for care workers. Looking at the recent report from the Select Committee, Kathy Roberts, Chair of the organisation, shares why.

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Six steps to preparing a care business for sale For some, this year has left them with no option but to sell their business. Here, Hazel Phillips, Partner at Royds Withy King, sets out the steps to make sure your business is in the best possible position for sale.

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Understanding and managing your mental health Maintaining good mental health has been a struggle for many with the events of 2020. To help, Marc Caulfield from Demolish the Wall explores the science behind mental health and gives practical tips on supporting yourself and those around you.

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Where next? Social care technology trends post-COVID-19 As social care technology holds government’s and regulators’ attention, Jonathan Papworth of Person Centred Software looks to the year ahead asking what changes it might bring.

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EDITORIAL editor@caremanagementmatters.co.uk Editor: Angharad Burnham Content Editors: Olivia Hubbard, Henry Thornton

CONTRIBUTORS

PRODUCTION Lead Designer: Ruth Clarry Director of Creative Operations: Lisa Werthmann Studio Manager: Jamie Harvey

ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertising Manager: Daniel Carpenter daniel.carpenter@carechoices.co.uk Assistant Advertising Manager: Aaron Barber aaron.barber@carechoices.co.uk Director of Sales: David Werthmann david.werthmann@carechoices.co.uk

@CQCProf

@LlpGordons

@KathyRobertsMH

@blimeysimon

Debbie Ivanova Deputy Chief Inspector of Adult Social Care, Care Quality Commission

Neil Grant Partner, Gordons Partnership LLP

Kathy Roberts Chair, Care Provider Alliance

Simon Bottery Senior Fellow, Social Care, The King’s Fund

@clentonF

@RWK_SocialCare

@DemolishTheWall

@PersonCentredSW

Clenton Farquharson MBE Chair, Think Local, Act Personal

Hazel Phillips Partner, Royds Withy King

Marc Caulfield Chief Executive and Co-Founder , Demolish the Wall

Jonathan Papworth Co-Founder and Director, Person Centred Software

SUBSCRIPTIONS Non-care and support providers may be required to pay £50 per year. info@caremanagementmatters.co.uk 01223 207770 www.caremanagementmatters.co.uk Care Management Matters is published by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters © Care Choices Ltd 2020 CCL REF NO: CMM 17.9

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Caroline Waters OBE Interim Chair, Equality and Human Rights Commission

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From the Editor As 2020 draws to a close, I find myself looking back at where I expected this year to go.

Ever the optimist, I thought that we’d have a clear idea of how Government planned to tackle any impact of Brexit on the sector, that we would be examining plans and proposals for the reform of social care, and that the national recruitment drive that had just been launched would see some of the staffing issues resolved.

I thought that promises made might just be kept, that we’d have support to develop and innovate and that ageist and hate-fuelled opinions might slowly begin to change.

This has not been the case.

This year, the sector has battled through an incredible (and I use that term literally) experience. Whilst theories around whether or not Government could or should have seen this coming continue to raise discussion, there was absolutely no way that the adult

social care sector could have been prepared.

And yet, in what has been an utterly challenging year, we have seen the spirit of adult social care break through. In the midst of a second wave, there is optimism that we are in a better position than at the start of the year, that we can handle this – and handle it well.

Amongst the awfulness, there has been progress. There is more knowledge sharing, a wider public appreciation of the sector, serious (if short of the mark) consideration of social care from Government, and an acknowledgement, at least from within, of our ability to react quickly and effectively in times of crisis.

I do wonder whether Government has finally learnt the catastrophic cost of pushing back reforms and will make this a priority. I wonder if it will listen to and collaborate with the sector, and whether it will accept that the jumbled and unhelpful

Editor, Angharad Burnham looks back at the expectations and realities of 2020.

guidance produced this year could have been avoided with the invaluable input of voices of people with lived experience. I only hope that lessons have been learnt.

There are undoubtedly more difficulties on the path as you strive to provide the best care possible for the people you support and their families.

Things will likely continue to feel hard – at times impossible – and frustrations are almost certainly going to arise. Looking ahead at what we have to come in 2021 can feel daunting, but while we are focusing on the future, we

must not forget how far we have come.

I hope you all get a chance to enjoy the festive season and take a break. CMM will return in January 2021 with more content to help you run your business with confidence as we hope for an easier 12 months.

In the meantime, don’t forget to sign up for free to the CMM website, where you’ll find all our COVID-19 special editions, tips on mental health for registered managers, and daily news alerts to keep you informed. Visit www. caremanagementmatters.co.uk and click ‘sign up’.

Email: editor@caremanagementmatters.co.uk Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk

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COVID-19 is dominating both media headlines and our lives at the moment but that doesn’t mean we can ignore other important findings in health and social care. In fact, in the learning disability, autism and mental health sectors COVID-19 has accentuated existing poor practice and highlighted the need for urgent action to protect people.

Our latest report, Out of sight – who cares? highlights some of these urgent issues. It looks at the use of restraint, seclusion and segregation in services for people with a learning disability, autistic people and those with a mental health condition. It brings together people’s personal experiences with what we found during surveys and visits to select hospital, adult social care and children’s services.

We’ve told this primarily through the voice of people who have experienced restrictive practices, and the report has human rights at its core. We’re calling for increased national oversight in commissioning and across government, to stop people falling through the gaps.

Restrictive practices are not an appropriate way to care for people. They happen when we haven’t got the model of care right and haven’t properly understood people’s needs.

Using a human rights perspective can help reduce the use of restraint significantly. When staff think about what an individual might need for them to have their basic rights, they see things differently.

When people receive undignified and inhumane care it is our collective responsibility to bring about change. This must be a change both in the model of care and the oversight of it.

Community-based services are the best place to care for people with a learning disability, autism and/or a mental health condition, and it is possible to make this a reality even for people who have been subject to long periods in hospital and cycles of restrictive practice.

A lack of training and support for staff means that they are not always able to care for people in a way that meets everyone's individual needs. We must have community teams across the country with specialist skills to support autistic people, people with a learning disability and/or mental health conditions, intervene early and prevent people from having a crisis.

Inside CQC D E B B I E

I V A N O V A

Debbie Ivanova, Deputy Chief Inspector of Adult Social Care at the Care Quality Commission (CQC) explores key recommendations in Out of sight – who cares?

So, what does increased oversight look like?

We want the government to appoint a national commissioner for complex care who would deliver our recommendations, working with delivery partners in health, education, social care, justice and local government.

Delivering good care in a system with complex funding arrangements and workforce shortages is undoubtedly difficult, but it can be done.

Key to this is our recommendation for a national reporting mechanism to be developed for the use of restrictive interventions in social care and children’s services to mirror that used in hospitals. We found that social care providers did not always recognise when they were using restrictive practice. We need common language, definitions and a unified system that allows us to track trends.

We’re also calling for enhanced monitoring by commissioners to help ensure a plan for ending an individual’s restrictions is in place and milestones for achieving it are met. The provider must have a named person with oversight who reports to the commissioner.

Where progress is not made, this should be escalated.

As part of our recommendations, we’re stating that human rights must be embedded in the commissioning and delivery of care. This is especially the case for children and adults with a learning disability, autistic people and people with a mental health condition.

People must have accessible information about their rights such as resources produced by the British Institute of Human Rights and the Equality and Human Rights Commission.

We’ll look for this on inspection and through our monitoring activity.

I cover only some of the recommendations here and I encourage you to read our report in full on the CQC website. We all have a part to play to ensure that improvements happen; our regulation is part of that. We’ll know that we’re succeeding when people who use services have their rights respected, are not segregated and restrained and have a true voice in determining where and how they live in the community.

Debbie Ivanova is Deputy Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and feedback on Debbie’s column on the CMM website, www.caremanagementmatters.co.uk CMM December 2020

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NEWS

APPOINTMENTS UKHCA

Care homes lockdown guidance The Department of Health and Social Care has published new guidance on visiting arrangements in care homes, in response to the month-long national lockdown which commenced on 31st October 2020. The guidance suggests the following options for ensuring safe visits in care homes: Using COVID-secure visiting areas/pods with floor to ceiling screens and windows where the visitor and resident enter through different entrances, are separated by screens and visitors do not need to enter or pass through the care home.

Visits at windows, where the visitor does not need to come inside the care home or where the visitor remains in their car, and the resident is socially distanced.

Outdoor visits with one other

person – visitors can meet outside with a loved one, in areas which can be accessed without anyone going through a shared building.

Further support for virtual visits, encouraging the use of video calls.

Vic Rayner, Executive Director of the National Care Forum (NCF), responded to the guidance, saying, ‘The NCF welcomes that the Government has ultimately recognised the central role that visiting plays in care home life and the sentiment expressed in the guidance offers a positive steer towards visiting becoming more common place across the country.

‘The guidance talks a good talk about how visiting can work in practice…but offers nothing in the form of support to providers to make it happen at the scale and pace that relatives and residents

both want and need…

‘It also needs to be made crystal clear to all that the decision to run these visits or otherwise can still sit outside of the gift of the home and their residents. The guidance sets out a very cautious approach to visiting…[and] Government has left the door open to blanket bans, emphasising the power of Directors of Public Health to close services across an area and thereby instantaneously shut down visiting. It is imperative therefore that we work together at local and national level to ensure the visiting guidance is implemented in line with the policy ambition, that homes are and remain open for visits – or it will forever be known as the guidance that gives hope with one hand – and takes it away with the other.’

COVID-19 deaths: people with learning disabilities A report from Public Health England (PHE) has shown that the death rate from COVID-19 for people with learning disabilities is significantly higher than that of the general public.

Deaths of people identified as having learning disabilities with COVID-19 in England in the Spring of 2020 examined data from The English Learning Disabilities Mortality Review (LeDeR) and NHS England’s COVID-19 Patient Notification System (CPNS) which records deaths in hospital settings.

The report found 451 per 100,000 people registered as

having a learning disability died with COVID-19 between 21st March and 5th June, a death rate 4.1 times higher than the general population after adjusting for other factors such as age and sex.

But as not all deaths in people with learning difficulties are registered on these databases, researchers estimated the real rate may have been as high as 692 per 100,000, 6.3 times higher than the general public.

Deaths were spread much more widely across the age spectrum among people with learning disabilities, with far greater mortality rates in younger

adults compared to the general population. The death rate for people aged 18 to 34 with learning disabilities was 30 times higher than the rate in the same age group without disabilities, researchers found.

The report also noted that, among people with learning disabilities, the rate of COVID-19 deaths for adults in residential care was higher than the rate of COVID-19 deaths of adults with learning disabilities generally.

This difference is likely in part to reflect the greater age and disability of people in residential care.

Five new non-executive directors have been elected by members to the Board of United Kingdom Homecare Association (UKHCA).

Mario Abajo Menguez, Chief Executive Officer of Clece Care Services Ltd, Nancy Cross, Director of Gofal Ystwyth Care Ltd, Carolanne Mainland, Director of Operations at Highland Home Carers Ltd, Polly Munyeza, Registered Manager at Support Unlimited UK Ltd, and Martin Ross, Director of Care at Home, Care South, have all been appointed.

Standing down are Roger Booker, UKHCA’s ViceChair, David Chalk, UKHCA’s Honorary Secretary, Lynn James, representing providers in England with three or fewer branches and Gavin StedmanBryce, representing providers in Scotland.

VALORUM CARE GROUP Esa Reeman has been named Valorum Care Group’s Managing Director with responsibility for the day-to-day operation of the Group’s schemes in England. She moves into the role from her previous position as the Group’s Managing Director for the southern region.

Esa has held a variety of senior management roles, including Chief Executive for South West-based Carmel Care & Support. Her new role has responsibility for 39 CQC registered services and a 1,500 strong care team.

INSPIRED VILLAGES Inspired Villages Group has announced Sharon Badelek as Chief Financial Officer, in a newly-created position. Sharon brings over 20 years’ experience growing customer-centric businesses across the UK. CMM December 2020

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NEWS

Industry leaders set out reform Leading figures in the care industry, spearheaded by Surrey Care Association, have set out what they believe to be the key reforms needed within social care to secure its long-term future in the wake of COVID-19.

The suggested reforms are offered in a bid to reinvent social care, by improving its funding,

efficiency, working conditions, and public image.

Surrey Care Association has produced a 60-page manifesto, which outlines the key steps they think should be taken to overhaul and reinvigorate the sector.

The five core components to reinvent social care are:

1) A fresh start with a new name, and a new ethos.

2) A valued workforce.

3) New processes led by people who access services.

4) Fair and transparent funding arrangements to secure a bright long-term future.

5) Reformed roles and structures.

The initiative has been launched with a virtual roundtable event, chaired by Professor Martin Green OBE, Chief Executive of Care England, which, alongside the directors at Surrey Care Association, was also attended by the Rt Hon Jeremy Hunt MP and Sir Robert Francis QC, Chair of Healthwatch England.

NHS Digital launches new care standards New care standards for integrating key health and social care information will ensure services can work better together to provide more personalised care.

The standards have been commissioned and led by NHS Digital and produced by The Professional Records Standards

Body (PRSB).

More than 1,000 people, including frontline health workers, patients and carers, helped develop the new standards as part of a consultation which also involved clinical and professional groups, charities, suppliers and researchers.

The standards will ensure

important personal details are recorded and shared with their care team.

The five new standards will cover: • ‘About me’ - the personal details that a person would like to be recorded about themselves.

• Health and care information

shared in care homes.

• Information shared by local authorities.

• Referrals for community assessments for care and support after a hospital stay.

• The urgent information needed when a person is transferred to hospital from a care home.

Nursing workforce numbers grow Latest figures from the Nursing and Midwifery Council (NMC) reveal the number of nurses, midwives and nursing associates on its permanent register has grown by 7,909 to 724,516 between 1st April and 30th September.

During the same period in 2019, an average of 765 overseas professionals joined each month, but in 2020 the average was just 351. In June 2020, just five professionals joined from outside the EEA. Figures also show more

professionals choosing to stay on the permanent register from the age of 56, with the number of people in that category rising by 4,954 to a total of 150,531.

At the same time, the number of those aged 21 to 40 grew by 4,837 to a total of 284,567.

The mid-year registration data report also includes figures from the NMC’s COVID-19 temporary register. At the end of September 2020, there were 12,756 former nurses, midwives and overseas professionals registered.

news of changes to Public Health England (PHE). The COVID-19 pandemic has made this goal even more important, says the think tank.

According to the report, the virus has starkly exposed how a lack of action on prevention and

population health improvement has compromised the nation’s health, especially in the most vulnerable communities.

Visit The Policy Exchange website to read the report, www. policyexchange.org.uk.

Saving a lost decade The Policy Exchange has outlined how a new proposed deal for public health could help to build a healthier nation in a new report, Saving a lost decade. This aims to provide some of the answers that have been central to parliamentary

debate during the COVID-19 pandemic.

This first public health report from Policy Exchange specifically looks at the structures of the public health system and improvements that can be made following the

ADASS and TSA launch Commission Two national care bodies have joined forces to make recommendations to government, health, care and housing sectors and the technology enabled care (TEC) industry, on the role of digital in a reformed adult social care system.

The Association of Directors of Adult Social Services (ADASS) 10

CMM December 2020

and the TEC Services Association (TSA) have set up a Commission to explore how better access to technology could improve joint working between health, social care and housing.

The Commission will bring together influential figures from adult social care, health and

housing, including local authority directors of adult social services, chief executives from councils, care and housing bodies and leaders from NHSX, Department of Health and Social Care and the Local Government Association. The voice of people who use services will be represented by Think Local, Act

Personal (TLAP).

In March 2021, the Commission will launch its final report, which will include a series of practical recommendations to central and local government on how to scale up and mainstream the use of everyday devices, data insights and specialist technology.

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NEWS

New platform launched to unite the global care community A care and culture consultancy group to the health and social care sector is preparing to launch a new platform to connect people through an international network of like-minded care communities.

Meaningful Care Matters’ comprehensive Meaningful Connections Community platform

will offer individuals and care providers an opportunity to share, collaborate and debate issues impacting person-centred care cultures.

The platform will also offer regular accredited online courses and resource tools such as blogs, podcasts, and short films, in a

bid to further help care providers develop together. Ultimately, the idea is to create and grow a community that can support each other through the ongoing challenges of the pandemic and beyond.

To find out more, visit www. meaningfulcarematters.com/mcc.

Research into falls prevention programmes Two population screen and treat programmes commonly prescribed to prevent older people falling have no impact on reducing fractures, researchers from the University of Warwick and University of Exeter have concluded.

As part of the largest clinical trial of its kind in the UK, funded by the National Institute for Health Research, the team examined two approaches to preventing falls in older people to find out if they also

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CMM December 2020

resulted in fewer fractures. Results showed that these programmes are not effective, when using a population screening approach, in reducing fractures in older people.

Up to one in 20 older people with a history of falling sustains a fracture annually, with some being admitted to hospital or needing to move to a care home.

The study examined two screen and treat programmes: multifactorial fall prevention (MFFP), and

exercise for people at increased falls risk.

Lead author, Professor Sallie Lamb of the University of Exeter, said, ‘Whilst this is a disappointing result, it shows that we must continue to invest in research and development to reduce fractures in older people. We need to think about the broader causes of fractures, and also understand more about what happens to cause falls.’

Inspired Villages Inspired Villages has finalised its partnership of nine construction firms to support the delivery of its extensive development plans for the south of the country. Inspired Villages currently has six villages in operation, three of which have construction of further residential phases ongoing. The company’s seventh and eighth villages are also under construction, with works expected to commence on four further villages in 2021.

The Construction Partners, which include Castleoak, Highwood, Graham, Kier, Stepnell, Thakeham, Vistry, Wates and Willmott Dixon, have been selected based on their expertise, ingenuity and ability to work to a predictable and consistent timeline, as well as a track record in delivering the highest quality retirement communities within allocated timeframes and budget.

NEWS

Call to prioritise winter funding for social care The Association of Directors of Adult Social Services (ADASS) is calling on Government to provide discrete winter funding for social care.

ADASS is campaigning to ensure that working-age disabled adults and older people continue to get the care and support they need in their own homes, and to fund

carers’ breaks so that councils can protect unpaid family carers.

According to ADASS, the ‘human cost’ of the COVID-19 outbreak to date underlines why Government must act now. It is recommending that Government urgently provides an additional £480m for increased care at home, home first, Shared

Lives and community support, as well as an urgent package of support for carers.

James Bullion, ADASS President, said, ‘To date, the response to the pandemic has centred almost exclusively on the NHS and to a lesser extent on care homes.

‘That is why we are calling

on the Government to provide £480m to ensure that older people and working-age disabled adults continue to receive the care and support they need in their homes over the winter, and a further £1.2bn to ensure that unpaid family carers get the breaks they need over the coming months.’

Social care: funding and workforce The Social Care Select Committee has published its report, Social care: funding and workforce, which outlines the current funding problems in social care, considerations on pay and training for the workforce and longer-term options about how to reform the social care system overall.

A key finding in the report is that despite more funding being made available, demand has grown over the same period – money has had to go further. The Health Foundation estimates that simply

meeting the growing demand for social care caused by an ageing population will cost £2.1bn per year.

This latest report also compares how much money the UK spends on social care compared with other European countries finding that, on average, it is far less than most.

Regarding workforce pay, it’s reported that 20% of care workers are paid only the National Living Wage, with one in five care workers under the age of 25 paid less than this. The proportion of care workers paid on, or above, the Real Living

Wage has decreased significantly, from 25% in September 2012 to just over 10% in March 2019.

Commentary in the report also delves into what the impact will be on social care workers who have worked on the front line during the coronavirus pandemic.

A significant proportion of the report discusses the financial implications of social care for people who must use their personal funds to pay for it. Real-life stories are used to argue whether the current system is fair and alternative

options for reform are outlined on how to reform the social care system. One such example is Japan and its introduction of universal social care packages for those who need them. The system is funded through general taxation and through ‘premiums’ paid by all people over 40 at a rate of 1% income. The report also signposts to Sir Andrew Dilnot’s Review and the introduction of a lifetime cap on care costs.

Read the full report on the parliament.uk website.

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NEWS / IN FOCUS

New report on hospital discharge

IN FOCUS

Healthwatch England and The British Red Cross have released findings from a new report on hospital discharge processes during the COVID-19 pandemic.

According to new Healthwatch and British Red Cross research, patients felt unready to leave hospital and missed out on vital follow-up visits and assessments during the first five months of the coronavirus pandemic. The research was carried out to better understand the impact of emergency measures

Care home testing for visitors

implemented earlier this year to free up beds for COVID-19 patients.

Over 500 patients and carers (both paid and unpaid) across England took part in the survey, which gathered people’s experiences from late March to late August.

Meanwhile, eight local Healthwatch services and partners around the country carried out 61 in-depth interviews with key staff groups involved in the discharge process.

The full report can be accessed on the British Red Cross Website.

Fairer for Carers Campaign Carers UK and 74 other organisations representing unpaid carers, disabled adults and children, and older people, have joined together to amplify their previous call on Government to recognise the financial pressure carers face this winter.

The Government has not acknowledged or responded to the initial letter, which was sent on 3rd July 2020. The letter was signed by 92 leading national and local organisations who provide vital support for carers and their families.

Research by Carers UK shows well over a third of carers receiving Carer’s Allowance – £67.25 a week for 35 hours or more of care – are

struggling to make ends meet, with 15% having been in debt because of caring. Earlier research with the Universities of Sheffield and Birmingham found more than 100,000 unpaid carers in the UK have had to rely on food banks during the pandemic.

Helen Walker, Chief Executive of Carers UK, said, ‘It can only be right that we give back to carers who have done so much for others.

Without this help, many will continue to face real hardship and suffering. The Government must act now to make Carer’s Allowance Fairer for Carers.’

To find out more, visit the Carers UK website.

Surrey care home fined over £100,000 A care provider has been ordered to pay £125,745.87 at High Wycombe Magistrates’ Court, following an incident which led to a 92-year-old woman being assaulted.

Sunrise of Esher notified the Care Quality Commission (CQC) on 12th June 2016 that an elderly man living in the service with dementia had assaulted Mrs Eileen Traynor with his zimmer frame whilst she was in bed.

Sunrise Operations Esher Ltd, which runs Sunrise of Esher, was

fined £100,000 in court. The court also ordered Sunrise Operations Esher Ltd to pay a £170 victim surcharge and £25,575.87 costs as a result of the prosecution brought by the CQC. Debbie Ivanova, CQC’s Deputy Chief Inspector of Adult Social Care, said, ‘This is a very distressing case and clearly Mrs Traynor did not get the safe care she was entitled to. I would like to offer my heartfelt condolences to all of those affected by Mrs Traynor’s death.’

WHAT’S THE STORY?

The Department of Health and Social Care launched a pilot on Monday 16th November 2020, for family members and friends to get regular testing to enable them to visit loved ones in care homes.

The pilot will take place in around 20 care homes across Hampshire, Cornwall, and Devon and will be rolled out more widely in December, in time for Christmas.

The pilot, which forms part of plans to roll out mass testing technology across the country, has been made possible due to an expansion in the country’s testing capacity.

WHAT ARE THE DETAILS?

The pilot is taking place in local authorities with lower transmission rates to ensure it can be done as safely as possible. Regular testing will be offered to one family member or friend per resident, which, when combined with other infection control measures such as PPE, will support meaningful visits to take place, including (where possible) indoor visits without a screen, while reducing the risk to care home residents, staff and visitors.

Visitors will be offered either tests which they can do at home, or the new 30-minute rapid lateral flow tests which can be administered in person at care homes before a visit.

Each care home receiving lateral flow tests will receive a box of 675 initially and will be given access to more as required.

Care staff are being trained to ensure tests are administered safely and accurately.

WHAT WOULD THE IMPACT BE?

The Department of Health and Social care says if the pilot is successful, care home testing will be rolled out in a phased way across the country. Any decision on a national rollout will be taken in light of the latest available data on transmission rates as a result of national COVID-19 restrictions.

If these faster tests work in this setting, the Government will ring-fence supply to open more chances for visiting.

WHAT DOES THE SECTOR SAY?

The Independent Care Group (ICG) said this pilot was welcome news for all residential care providers.

ICG Chair, Mike Padgham, said, ‘Separating care and nursing home residents from their loved ones for a prolonged period has been one of the most distressing aspects of the coronavirus pandemic and has been very damaging for both parties' mental health and wellbeing.

‘Providers are very keen to enable visiting again but of course want to do so in the safest way possible for the residents, families and staff at the homes.

‘Our pleasure at this pledge is only tempered by the fact that we have had Government promises before and they have failed to materialise.

‘We question whether we need to have the pilot programme – which has only just started at 20 homes. By the time that pilot has been completed and the results considered, we will be getting perilously close to Christmas. Our advice would be to press ahead with getting testing kits and training out to the homes as soon as possible and not delay any further.’

CMM December 2020

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NEWS

Hamberley Development Plans to build a new luxury care home on the old Bargain Farm site in Nursling in Southampton have been given the go ahead.

Work is due to begin in the first quarter of 2021 with the home welcoming its first residents in the summer of 2022.

The home will include 80 en-suite bedrooms, a café bistro,

a private dining room, a hair salon and nail bar, activity room/ bar, a cinema, spacious resident lounges, dining rooms and quiet lounges.

Additional features include a bespoke COVID-secure visitation suite, in-built thermal imaging technology in the entrance lobby (to ensure all visitors to the

home, including staff, have their temperature taken on a daily basis) and a ventilation system which ensures air in resident and day spaces is fully changed every 15 minutes.

A neurological rehabilitation facility will be also built adjacent to the care home, with both being built by Hamberley Development.

Because We All Care update The Because We All Care campaign has found that people over the age of 55 are the age group least likely to think care has improved over the pandemic.

The joint campaign also reveals research which shows those over the age of 55 are the group most likely to believe providing feedback on care makes a difference.

With over 55s usually accessing care more frequently than most

of the population, as well as often providing support to family and friends, CQC and Healthwatch want to continue to hear about their experiences of care.

Research so far has found that people over the age of 55 with experience of health and social care: • Are less likely to think that care has improved during the pandemic.

• Are significantly less likely to

think that it is acceptable for health and social care providers to offer a lower standard of care due to the impact of coronavirus.

• Are more likely to think a decline in care is unacceptable.

• Are less optimistic that increased support and empathy from family and the wider community during the coronavirus crisis will persist than younger generations.

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CMM December 2020

CARE badges available to order CARE badges are now available to order for all adult social care organisations.

The badges are free for anyone working in adult social care and aim to provide greater recognition of the amazing care and support the profession provides.

All those placing orders will also be sent a hard copy of both a ‘health and wellbeing’ and ‘three important actions for winter’ flyer.

A digital download will also be attached to the confirmation email so providers can print extra copies for the workplace.

The posters are also available to download.

CARE badges can be ordered from https://badges. adultsocialcare.uk.

NEWS

Call to help people with disabilities Leonard Cheshire has called on Government to act now to avoid a jobs crisis for people with disabilities.

The charity surveyed 1,171 working age people with disabilities and 502 employers, revealing the scale of the impact on jobs from COVID-19. It uncovered a 'crisis of confidence' among young people with disabilities.

Key findings included:

• Seven in ten disabled people (71%) have been impacted by loss of income, furlough, unemployment or other damaging effects as a result of the pandemic.

• 42% of employers were discouraged from hiring disabled job applicants due to concerns around supporting them properly during the pandemic.

• One in five employers (20%) say

they would be less likely to hire someone if they were disabled.

For many 18-24 year olds with disabilities, the impact was psychological. More than half (57%) said they felt that the pandemic had affected their ability to work, and 54% that it had impacted their future earnings potential.

To read the final report, visit Leonard Cheshire’s website.

Rise in young people wanting to work in health and social care New figures from GetMyFirstJob. co.uk show that coronavirus has had a major impact on career preference, with a huge rise in the proportion of young people who now wish to work in health and social care.

Comparing data from July-September 2019 to July-

September 2020, the research suggests that desire to work in health and social care rose by 79%. This represents the largest rise of any sector.

Health and social care has leapt from the 10th to the 4th most preferred career pathway for young British people.

The figures are part of one of the most robust national assessments of post-education career preference. Over 25,000 school, college, and university leavers register with GetMyFirstJob every quarter and specify which sectors they would prefer to work in.

No change to CQC fees scheme The Care Quality Commission (CQC) has announced that its CQC fees scheme, which covers all the Commission’s costs of regulation, including registration, monitoring and inspection, will not change for 2021/22.

This news means that, for most providers, their fees will remain the same as in 2019/20 and 2020/21, provided their registration or size does not change. NHS trusts, NHS GPs and community social care providers may see a small change to their fees from April 2021 (up or down), because each provider’s fee is calculated by looking at their size against the total size of the sector, both of which change year-on-year.

However, the total fees collected for each sector will not change.

Due to the fees not changing, CQC will not be consulting on fees this year.

CMM December 2020

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NEWS

Places for People Group Living Plus, part of the Places for People Group, has extended its affordable living portfolio into North East Lincolnshire, creating a new extra care development in Grimsby.

Burchester Court is the company’s first affordable Extra Care development in Grimsby.

Places for People partnered with Morgan Sindall Later Living and Esh Construction, who have built the site, alongside North East Lincolnshire CCG and Homes England.

Open to local over-55s who have care and support needs, or

those who may develop them in the future, Burchester Court will offer 24-hour on-site care, a Garden City café, a hair and beauty salon as well as lounges and gardens. The homes comprise one- and two-bed apartments, all with accessible and open plan living space.

Homecare sees the business expand its geographic location, providing services throughout the East Midlands and South East of England.

ThinCats has also provided a £3.3m funding package for

Manchester-based care home operator, We Care Group.

We Care Group has built a group of 15 homes to date, providing 730 beds across the North and North West of England and employing more than 650 staff.

ThinCats ThinCats has provided £8.5m in acquisition funding to Care at Home Services for its counterpart, Westminster Homecare.

Care at Home Services has bases across East Sussex and Kent.

The acquisition of Westminster

Signature Senior Lifestyle Beard has been awarded contracts worth a combined £25m with Signature Senior Lifestyle, to build two of its new developments in the South East.

The sites in Caversham, Berkshire and Farnham Common, Buckinghamshire are both expected

to be completed in 2022, providing luxury care homes and assisted living communities for older people in need of nursing, respite or dementia care. Caversham will comprise 86 apartments, with communal facilities including a café, restaurant, cinema, lounge areas, activity room,

a pub, spa bathrooms, hair salon and therapy room.

Farnham Common will offer luxury assisted living and nursing in 74 studio-style bedrooms with private wet rooms, with the same range of facilities on hand to residents.

Marie Curie to support Care UK Marie Curie and Care UK are working together to provide additional support to care home teams and to help prepare for any future virus outbreaks.

Marie Curie will work with Care UK on its approach to end of life care, including evaluating current training and practice, providing support to home managers to enhance resilience among team members and being on hand for those who need a space to share, reflect and learn, with the opportunity to speak to Marie Curie

experts about any aspect of end of life care.

In homes affected by coronavirus, Marie Curie will provide support to the entire care home team via the Marie Curie Professional Companions programme. Marie Curie will also provide recommendations about additional support that might develop and reassure teams in the future.

Eamon O’Kane, Deputy Director, Devolved Nations & National Programmes at Marie Curie, said, ‘As a charity, Marie Curie’s mission

is to improve the experience of dying, death and bereavement for all. We provide direct end of life care in communities across the UK, but we will make greater impact in our mission by working with organisations that have a delivery role in end of life care.

‘We have experience, resources and services that can help the care home sector and welcome the approach from Care UK. Working together ensures patients, residents and carers will ultimately benefit from the best end of life experience.’

Royal British Legion A state-of-the-art dementia care refurbishment scheme delivered across a live Royal British Legion care home has been handed over

by J Tomlinson’s refurbishment and engineering team.

The £2.3m project took place 18

CMM December 2020

at Galanos House in Warwickshire – one of six care homes owned and run by the Legion.

Works undertaken included creation of two extensions to support increased capacity within the home, as well as

landscaping and car parking works. As well as providing ten additional dementia care bedrooms, J Tomlinson created a new community hub which features a day care facility, café and treatment rooms.

Fornham House Fornham House in Fornham St Martin, near Bury St Edmunds, which provides residential care for up to 73 people, is nearing completion of a significant extension programme that will see the creation of a new selfcontained, dementia-specialist wing for up to 17 people.

Healthcare Homes Group, which owns Fornham House, has confirmed that £2.3m is being invested in the project. This will create 10-15 new job roles at the home, which already employs 70 people from the local area.

Autism Together unveils new respite service Autism Together has unveiled a new short-stays respite service at its Raby site in Bromborough, Wirral.

This nine-bedroom development was built to offer more flexible accommodation to suit the needs of people with autism and their families.

Formerly known as Helen House, The Maples has been completely redeveloped by North West Construction, with a redesign from Edward Architecture to Autism Together’s specifications.

Brendoncare St Giles View The Brendoncare Foundation has announced the completion of a new deal for the development of a 60-bedroom care home in Winchester.

The new home, Brendoncare St Giles View, will be in Quarry Road, in the St Giles Hill area of Winchester.

It will be developed by Octopus Real Estate’s in-house healthcare development team and is due to open in the spring of 2022.

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Right support, right care, right culture: Have they got it wrong?

CQC’s registration and regulation of providers supporting autistic people and people with a learning disability has long been a contentious issue. Here, Neil Grant, Partner at Gordons Partnership LLP asks, has anything really changed with the publication of its new guidance, Right support, right care, right culture?

On 8th October 2020, the Care Quality Commission (CQC) issued new statutory guidance to the learning disability and autism sector. Right support, right care, right culture (RRR) replaced Registering the Right Support (RRS), which had been in place since June 2017. In fact, the original version of RRS had been issued in early 2016 without any real consultation with the sector.

RRS defined what would be acceptable in terms of new community services and close inpatient facilities for people with a learning disability or autistic people who display behaviour that challenges.

For the first time, CQC adopted a market-

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CMM December 2020

shaping role, becoming the standard-bearer of the national service plan and model promulgated under Building the right support, which was issued by NHS England, Association of Directors of Adult Social Services and Local Government Association in October 2015. The national model forms part of the Transforming Care agenda, the response to the appalling events at Winterbourne View.

HOW WE GOT HERE The intent behind Building the Right Support is laudable, focusing on reducing the number

of people with a learning disability, autism or both in inpatient settings by increasing specialist community provision.

The principles and values are centred around choice, independence and empowerment, which we would all support. However, what came to be hugely contentious was the set of rules relating to the size, location and design of new care homes, which was later codified in RRS. New care homes had to be small in scale (typically no more than six residents), in a residential area linked to the community, and meet local needs. Overnight, schemes were derailed, and others in the formative

stage shelved forever, leading to insufficient community provision, not more. Many applications to increase bed numbers in existing care homes were also turned down.

In the face of so much opposition from the sector, CQC consulted on a revised version of RRS, the final version published in June 2017. CQC stated that it was not adopting a ‘one size fits all’ approach and that it would consider proposals departing from the national model provided there were compelling reasons to do so. However, at the same time, CQC stated that new services should not be developed in a campus style or congregate manner.

In the guidance, campuses are defined as ‘group homes clustered together on the same site and usually sharing staff and some facilities. Staff are available 24 hours a day.’ Congregate settings are ‘separate from communities and without access to the options, choices, dignity and independence.’ If, say, a provider has several existing care homes on a site, all rated Good or Outstanding, CQC will not register an additional one, as it offends the rule against campus style settings.

Equally, if a proposed care home is in a rural setting lacking local amenities, it is likely to be turned down based on it being a perceived congregate setting.

RIGHT SUPPORT, RIGHT CARE, RIGHT CULTURE The focus of RRS was on applications to open new services or extend existing ones. However, the new RRR guidance expressly applies to existing services, as much as it does applicants for registration: ‘This guidance: • Applies to any service that currently, or intends to, provide regulated care to autistic people and people with a learning disability.

This includes children and young adults, working age adults and older people.

• Describes our regulatory approach for these services, covering our registration, inspection, monitor and enforcement functions.

• Makes our expectations clear to future and existing providers.’

CQC also applies the guidance to supported living schemes, even though it has no statutory role in regulating the accommodation element of such services. Indeed, several of the case studies relate to supported living services. One is left with the distinct impression that CQC has decided to extend its regulatory remit through its self-appointed market-shaping activity, even though the legislation gives it no express authority to act in this way.

The guidance goes on: ‘Providers of new services must

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CMM December 2020

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RIGHT SUPPORT, RIGHT CARE, RIGHT CULTURE: HAVE THEY GOT IT WRONG?

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demonstrate, and providers of existing services are expected to demonstrate, how they will meet: • Our characteristics of ratings for good in healthcare and adult social care.

• The regulations (including fundamental standards).

• People’s expectations, as set out in the service model.

• The requirements in this guidance to demonstrate that: 1. There is a clear need for the service and it has been agreed by commissioners.

2. The size, setting and design of the service meet people’s expectations and align with current best practice.

3. People have access to the community.

4. The model of care, policies and procedures are in line with current best practice.’

IMPLICATIONS FOR PROVIDERS CQC acknowledges that some providers will not meet the national model, saying, ‘We expect providers to show how their service meets the needs of people in line with current best practice. If they do not follow best practice in any way, they must provide compelling evidence that demonstrates how their alternative approach will deliver appropriate and person-centred care.’

It seems likely that services rated Good or Outstanding will be left alone as CQC can argue that their models of care align with Building the Right Support, even if their location and size do not accord with perceived best practice. However, one can imagine it will be different for those services rated Inadequate or Requires Improvement. Increasingly, there will be pressure on CQC to take enforcement action to remove what it sees as ‘institutional’ services that cannot justify being out of alignment with the national model.

Paul de Savary, Managing Director of Home from Home Care, runs nine Outstanding and two Good care homes for people with a learning disability and/or autism. Paul has been campaigning since 2016 for CQC to change its guidance to acknowledge the small cohort of individuals with the most complex, challenging needs who do not fit into CQC’s doctrinaire approach. He says of the new guidance, ‘You have to ask a simple question.

Given that RRS collapsed new specialist residential services to exit individuals from Assessment and Treatment Units (ATUs) – where over 2,000 of the most vulnerable suffer by way of restriction, restraint and medication

– does RRR rectify this shocking, inhumane reality?

‘The answer is another ‘R’, rhetoric, and another, reality, or in this case, lack of. Extraordinarily, RRR simply ramps up discrimination against individuals with autism by continuing to treat them as a single cohort, to be corralled into a now even narrower CQC model of care. Given RRS’s failure, it is now negligent that RRR dogma excludes input from best practice residential providers which CQC rates Outstanding, or indeed from its own inspectors.

‘RRR’s top-down driven approach excludes fundamental operational realities: the evolution of property (single person apartments in place of beds) and data-driven care that creates transparency and realtime accountability. As RRS before it, RRR’s dogmatic and throttling message strangles imperative innovation and will only prolong the suffering of those incarcerated in ATUs. So blindingly obvious to the informed, yet, inexplicably, not to senior CQC management.

Rhetoric in place of reality.’

A CONSULTANT’S PERSPECTIVE Tim Dallinger from Social Care Consultants Ltd comments, ‘The legislation and statutory guidance in other parts of the UK are very different from that in England.

‘In Wales, almost no distinction is made between services for older persons and those with a learning disability and/or autism.

The only difference is the regulations about physical space requirements, which are less onerous if the application is for a new service or an extension and the total number of people supported is four or fewer.

‘In Scotland, the Keys for Life strategy for learning disability services was launched in 2019. I can see nothing in this strategy which places restrictions on the size of a service, although the overall aspirations of the strategy are very similar to RRR. ‘In Northern Ireland, the Regulation and Quality Improvement Authority (RQIA) has no specific guidance for services supporting people with a learning disability and/or autism.

Instead, this issue is considered on a case by case basis.

‘RRR makes it clear that registration applications must be consistent with local authority Market Position Statements . Many of these were written a number of years ago, and some omit specific commissioning requirements around services for people with

a learning disability. Others refer to the wish to commission supported living services when, in practice, commissioners continue to place people with a learning disability in care homes and larger services.

‘So, where does this leave providers?

Confused and in limbo. I am supporting a Good provider who has an existing registered service with more than six beds. An application was made to increase the number of registered places to meet local need. The application process was interrupted by COVID-19 but CQC has advised that the application will be rejected. The provider has no idea how the new guidance will affect the application and has turned down numerous referrals when it could have provided a service which met the needs of those people.

‘Consistent UK-wide guidance which is in line with national and local commissioning strategies is needed to ensure commissioners, providers and people who require services know what to expect. Only then can this part of the sector thrive and prosper.’

ONGOING CONCERNS I have been involved in this debate for the last four years. What concerns me is how a regulator can adopt a market-shaping role when there is no express authority to support such activity, which now extends to the regulation of supported living services. There is also my secondary concern around the evidence base that ‘justifies’ a group setting of six or less being acceptable, but running the risk of becoming institutional between seven and ten. This evidence base is subjective, tenuous and easily rebutted by many examples of Outstanding services operating with those slightly higher numbers.

CQC’s focus is on upholding doctrinal purity at all costs, to the point where real life experience and track records are disregarded, even when it is clear new services would be outstanding and innovative. The most disappointing thing of all is that genuine choice is the first casualty of CQC’s approach.

We are told, ‘People expect providers to comply with Building the Right Support and the accompanying service model when designing or running a service.’ Yet this is an assumption used to back up CQC’s approach.

What it really means is that CQC knows what is best, even if people needing specialist community services, their families and commissioners might have the temerity to disagree.

CMM

Neil Grant is a Partner at Gordons Partnership LLP. Email: neil@gordonsols.co.uk Twitter: @LlpGordons What do you make of Right support, right care, right culture? What changes do you see and will they work? Share your views on the CMM website where you can comment on this feature, www.caremanagementmatters.co.uk 22

CMM December 2020

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This will not apply when hiring Irish citizens or those eligible for status under the EU Settlement Scheme.

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CMM December 2020

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CALLING FOR A BETTER FUTURE FOR SOCIAL CARE People working across the adult social care sector have long understood and articulated the need for sustainable reform. Looking at the themes in the recent report from the Health and Social Care Select Committee, Kathy Roberts, Chair of the Care Provider Alliance (CPA) shares why the organisation is calling for a long-term funding solution, workforce reward and recognition, and a clear career pathway for care workers.

The recent Health and Social Care Select Committee’s report shows the real-life impact of austerity within the care market over the last ten years and the increasing demand on all services across the country. The report, which is based on the insights of care experts including people who provide and use services, offers a moment of reflection on the shape of future care delivery.

THE FUNDING ISSUE The bedrock of all service delivery is tied to money and the flow of funding via the different routes that people pay for their care. One of the main recommendations

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CMM December 2020

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CALLING FOR A BETTER FUTURE FOR SOCIAL CARE

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within the Committee’s report is for Government to use the forthcoming spending review to invest £7bn more per year in adult social care by 2023/24.

Yet we know from the detailed funding analysis by the Health Foundation that this is a minimum step towards covering future care costs within our society, falling around £700m short of what would be required to meet increased demand, increase provision and support local authorities to pay providers more sustainable fees.

The social care system relies on crosssubsidy arrangements between people paying for their own care and those whose care is funded by their local authority. The National Audit Office report on adult social care updated in 2018 shows that this subsidy can be significant, with private care fees on average 40% higher than those paid by the local authority. This leaves providers commercially exposed or forced to pass on their operating cost shortfall to self-funded individuals.

COMPOUNDING FINANCIAL STRAINS In evidence to the Health and Social Care Select Committee, the Local Government Association (LGA) identified a sizeable in-year gap of £6bn attributable to the impact of COVID-19 across the sector. This is over and above the £3.2bn funding that was provided in the earlier part of this year by the Treasury to local councils. LGA and CPA both agree that this first £3.2bn was insufficient to cover the additional costs associated with the COVID19 pandemic. The Infection Control Fund rounds one and two have topped up some key financial gaps, but what we now face through the winter months is providers and councils struggling to balance their budgets.

The financial problems will continue to

mount with the recent announcement that the zero-rate on VAT for PPE for providers has ended. All providers will be impacted by this 20% increase on purchases outside the PPE Portal allocations. Providers that are not registered with the Care Quailty Commission (CQC) will be further materially impacted by this as they are not able to access any of the free PPE via the portal.

As well as the increase in infection control costs, services are facing falls in occupancy levels as families are concerned about placing loved ones in residential care. Recent figures from Carterwood show the 2020 monthly loss of care homes beds has risen to 1,500, three times that of last year’s average. Rises in staff sickness and absences are also leading to increased agency costs.

On top of this, the adult social care market is largely made up of charities who operate on a limited profit model, as their values often see them reinvesting within their services or running at a loss. The picture for these charities is bleak.

The latest Voluntary Sector Impact Barometer report shows that: • Almost 40% of voluntary organisations report that their financial position had deteriorated in the last month.

• 60% say COVID-19-related safety measures have increased their operating costs.

• 10% expect to have stopped operating by this time next year.

It is difficult to quantify the true extent the impact this pandemic has had and will have, however it does not seem unreasonable to assume that currently at least 50% of the whole adult social care market will be in a precarious financial situation. This is directly attributable years of underfunding, compounded by the budget impacts of the COVID-19 pandemic.

“It is difficult to quantify the true extent the impact this pandemic has had and will have.”

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CMM December 2020

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Our market fragility could be further exacerbated by the sleep-in judgements; we understand that in some cases, reserves set aside for back-pay may have already been used by providers in commercial distress. One more pressure on cash flow will be the final straw.

SETTING PRIORITIES The adult social care market is large; comprised of approximately 18,200 organisations across 38,000 locations, with a workforce of 1.52 million.

It is estimated to contribute £41.2bn per annum to the economy in England. In 2019/20, the total wage bill for the sector accounted for around half of this amount at £22.2bn (up 2% from 2018/19).

We consistently hear from our members that care workers are typically deeply committed to their work and enjoy working with the people they meet, whilst undertaking what can be a very difficult job well.

The values of staff are certainly a driver in this sector, but it would be naïve to say that pay isn’t a significant consideration – we all need to pay the bills at the end of the month – and despite some recent improvements in recruitment, the Skills for Care workforce report revealed that we still need over 100,000 care workers to come into the sector.

To fill this gap, not only will we need to attract new workers, but we will also need to reduce the 30% turnover rates typical in the sector, which will require a long-term, strategic approach to social care pay and conditions.

Care work should not be compared to a job in a supermarket, yet doing so allows us to see that retail staff, on average, earn 24p more per hour than a care worker, raising concerns about the wider issues on pay. This must be addressed.

The adult social care sector in England is a major employer and contributor to the economy and, as such, investment in the workforce should be a priority at a national level.

However, prioritisation is not what we see from Government. Care workers are not listed as an eligible occupation on the ‘Skilled Workers’ route of the new points-based immigration system, due to come into effect from January 2021, and despite calls by the Migration Advisory Committee to add senior care workers to the Shortage Occupation List, issues with recruitment have not been heeded.

Without support to improve conditions, the sector will now need to fight even harder to attract new staff.

This situation, amongst other issues, has led CPA to call for a long-term Social Care People Plan – similar to the NHS People Plan.

We want to see parity with our colleagues in the NHS, in terms of recognition as a skilled workforce, and in terms of reward through comparable pay and conditions. We want to see structured career pathways so that working in care is an attractive profession for everyone with the right values and commitment.

We want to ensure that instead of 20% of care workers being paid the National Living Wage, all care staff are paid the Real Living Wage (currently £9.30, and £10.75 in London), the cost of which has been calculated by the Resolution Foundation as £1.4bn per annum.

And research shows that the public supports this. In May 2020, the gender equality campaigning charity the Fawcett Society, found that 65% of survey respondents supported an increase in Income Tax to fund a pay rise for care workers, a figure that rose to 68% among Conservative voters. The Fawcett Society said, ‘The case for making a sustained investment in social care has never been stronger – the toll the pandemic has taken on this sector means that social care is no longer a hidden problem, but one that the country as a whole understands. We urge the Government to now address this crisis as a matter of urgency.’

THE TIME TO ACT We can all make a change to the small part of the system within which we operate and advocate. The overarching structure of our sector requires collaborative policy development with providers, reform that is centred around the voices of the people we serve and the funding overhaul to achieve these strategic aims within a long-term sustainable plan.

The CPA and all the national trade associations we represent would echo this quote from Sir Andrew Dilnot: ‘We have a system that does not work, does not look after the people who need it well, does not look after those who are providing the care well and does not provide an industry that is attractive to move into.

‘Reform is due now. It has been due for many years, but now seems like a really appropriate time to act.’

CMM

Kathy Roberts is Chair of the Care Provider Alliance. Email: info@careprovideralliance.org.uk Twitter: @CPA_SocialCare Where do you think reform is most needed? Tell us your thoughts on the CMM website, where you can leave feedback on this article, www.caremanagementmatters.co.uk CMM December 2020

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INTO PERSPECTIVE

WILL SOCIAL CARE REFORM MATERIALISE, AND WILL IT BE WORTH IT IF IT DOES?

The adult social care sector has been promised reform for decades, with numerous reviews, white papers, and commissions all generating new ideas for an improved system. All political parties recognise the need for change, and yet, despite repeated promises, systematic reform is nowhere to be seen.

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Since 8th March 2017, the sector has been hanging on the lips of the then Chancellor, Philip Hammond, who stated in his Budget that Government would, ‘set out their thinking on the options for the future financing of social care in a Green Paper later this year’. Almost four years later, the Green Paper on adult social care reform is yet to materialise.

It is fair to say that this Green Paper has been one of the most highly anticipated publications the sector has awaited in recent history. Most will argue that reform is long overdue, going back at least as far as the Labour Government’s March 1999 appointment of the Royal Commission on Long Term Care for the Elderly. While some of the Commission’s proposals were enacted, fundamental change was not undertaken at the time.

A GAME OF PRIORITIES In its 2017 general election manifesto, the Conservative Party repeated its intention to publish a Green Paper, promising to ‘build a cross-party consensus to bring forward an answer that solves the problem, commands the widest possible support, and stands the test of time.’

Its publication, however, got pushed further back, and, on 31st July 2019, the Financial Times reported that ‘a consultative paper that laid out options for funding care for elderly and disabled people’ had been pushed down the pecking order in favour of Government’s attention turning to Brexit.

This shift in focus birthed the idea of a White Paper, designed to bypass the time-consuming consultation needed to publish the Green Paper and provide a direct

pathway to reforming the adult social care sector.

Months passed until 14th January 2020, when the Prime Minister was questioned about social care reform during an interview on BBC Breakfast. The plan for social care reform that the Prime Minister said he already had back in July 2019 was confronted and its materialisation placed under scrutiny. The Prime Minister responded with an encouraging statement in that Government would be ‘bringing forward a plan this year, but we will get it done within this parliament’.

RUNNING OUT OF TIME Responding to a question at the then daily coronavirus press conference on 2nd June 2020, the Secretary of State for Health and Social Care, Matt Hancock, implied that it may not be possible to meet the previously set timetable for the reform of adult social care funding in light of the coronavirus outbreak. Furthermore, at a time where the need for real change has been exacerbated by COVID-19, the promise of reform has been subject to yet more delay, this time, beyond the calendar year.

Questioned over the Government’s plans in the House of Lords on September 15th, Lord Bethell, parliamentary undersecretary of state at the Department of Health and Social Care, said, ‘I cannot commit to a social care plan before the end of the year’. This, combined with years of inaction by Government, the ongoing challenges presented by COVID-19 and the extent of political collaboration required to enact reform, has caused the sector to become sceptical that a progressive solution will ever be put forward.

Inaction is often plucked from the jaws of reform

We must not leave problems for our children to resolve

Simon Bottery, Senior Fellow – Social Care, The King’s Fund

Clenton Farquharson MBE, Chair, Think Local Act Personal

The physicist Nils Bohr famously said, ‘predictions are difficult, especially about the future’.

So, it would be brave to say with certainty that social care reform will happen in the next few years or that it will be the reform that’s needed.

There is some cause for optimism. COVID-19 has shone a harsh, uncompromising spotlight on the sector revealing to far more people not just its flaws and fragility but also its value.

We have a government that has committed to fixing social care and included it in its manifesto.

It is being urged on by a long line-up of senior figures, in all parties, calling for large-scale reform and investment.

Yet the history of social care shows that inaction is often plucked from the jaws of reform.

Free personal care was recommended for England by the Sutherland Commission in 1999, but not implemented (in Scotland it went ahead).

The Care Act in 2014 was an outstanding piece of legislation, with its focus on wellbeing and personalisation, but it has never been properly funded.

A cap on care costs and

a more generous means-test was due to be implemented in 2016, but was delayed and then abandoned (it still sits on the statute book, where it joins a 2010 Gordon Brown reform that would have provided free care at home to those with the greatest needs, had Labour won that election).

Sometimes the care sector has been its own worst enemy, dismissing limited but positive proposals and holding out for a big bang reform which has never happened.

We need to accept that the scale and range of issues in social care – not just funding and eligibility but also issues like workforce, integration and quality – will have to be brought in over time and that compromises will have to be struck.

We also need to acknowledge the financial challenges that will face the country after COVID-19.

Yet we can and must also expect a clear, long-term vision and plan for the sector that provides a route map towards genuine, large-scale reform.

Will we see it? With a nod to Nils Bohr, I can only say ‘perhaps’.

’Not everything that is faced can be changed, but nothing can be changed until it is faced’. James Baldwin – American novelist, playwright, essayist, poet and activist.

We have had far too many false dawns on the promise of social care reform by governments of all colours.

So, if trust was the measure, the dial would be low. That might lead you to conclude that it may never happen. But by nature, I am an optimist.

COVID-19 has exposed the fault lines with the current system; it has also shown the best at the worst of times.

We now owe it to the public to seize the opportunity for transformation and not kick this into the long grass for our children to resolve.

Whilst we must have investment and a fair settlement between the state and individuals on paying for care, that is not enough. Successive governments have made the mistake of focussing on funding without asking what social care is for, or how it should work.

These elements of ‘form and function’ have been articulated

by Social Care Future in a vision that has a growing alliance of

supporters. This is simply ’we all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing things that matter to us’.

Achieving this means recognising that social care is everyone’s business, as disability can affect anyone of us at any time.

It must be inclusive, accessible and support people to lead their lives as best they can: a life not a service.

As chair of Think Local Act Personal, I am doing all that I can to press for a more human and relationship-based way of ‘doing social care’.

We are not passively waiting for the Government to ‘fix’ a ‘broken system’, but are taking active steps to get there, for example, by learning from the experience of mutual aid during COVID-19 and reaching out to civil society, local economies and people from diverse backgrounds.

The Government needs to step up to the mark and match the momentum and energy.

If they don't, we will leave our children a burden rather than an inheritance.

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CMM December 2020

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Taking care of skills

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HEADER

6 steps

to preparing a care business for sale It’s been a trying year for providers and things aren’t set to get easier any time soon. For some, the challenges of the year, compounded with previous difficulties, will have pushed them to a point where they can no longer operate. Here, Hazel Phillips, Partner at Royds Withy King, sets out the steps to make sure your business is in the best position for sale.

Despite an expected slowdown in the early days of the pandemic, activity in the care market appears to be increasing again. Deals which had previously stalled in the Spring are completing, albeit with some challenges with financing and a renewed focus on due diligence

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SIX STEPS TO PREPARING A CARE BUSINESS FOR SALE

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in areas such as occupancy rates, infection control, furlough and shielding.

Whilst there is activity, there is also uncertainty, particularly when it comes to timescales. Sellers can ensure they put themselves in the best position to complete quickly and achieve their offer price by preparing thoroughly. The quicker the sale goes through, the less opportunity there is for the unexpected, such as a drop in occupancy or retendering of a local authority contract, which can spook lenders and investors.

There are some key points for sellers positioning their businesses in both the homecare and residential markets, and these are set out below.

bonus agreement in return for loyalty and confidentiality to the point of completion.

1. Structure Sellers should take advice from their tax advisors from the outset to ensure the business goes to market with the most favourable tax structure. It is often the case that this is a share sale and this usually negates the need for a split exchange and completion. Where an asset sale is agreed and there is a gap between exchange and completion, careful thought will need to be given to how risk is allocated between the parties during that period.

Particular concerns for the buyer will be protecting against a potential reduction in occupancy, fall in income or an outbreak of COVID-19 amongst staff or the people using services. Sellers should work with their professional team to plan the timing of the transaction so as to minimise the period between exchange and completion and negotiate fair provisions to deal with the consequences of these events, should they occur.

4. Anticipating the issues We see a pattern of issues arise in care deals which concern buyers and hold up completion. These often relate to employees, in particular, sleep-in rates, failure to pay holiday pay correctly and incorrect use of furlough and shielding.

Sellers should face these head on. For example, providing detailed calculations on potential sleep-in liability at the outset will assist in both parties agreeing a sensible cap on liability whilst we await the outcome of the Supreme Court ruling on the Mencap case, which at the time of writing has not been delivered.

Similarly, calculating and repaying any holiday pay due will reduce the need for an indemnity in the contract.

2. Registered managers In an asset sale, the registration of the manager will need to be ‘fast-tracked’ to the incoming buyer. To optimise a quick completion, the appropriate Care Quality Commission (CQC) applications should be submitted at the earliest stage.

This inevitably involves informing the manager of the sale and brings with it concerns about confidentiality and stability. However, sellers can mitigate this by putting in place a

3. Frontloading due diligence Whilst it is reasonable to be mindful of incurring professional costs in the early stages, it can be hugely beneficial for sellers to start populating a data room at the offer stage whilst the buyer is arranging finance.

Quality information provided at an early stage instils confidence in buyers, investors and lenders, puts momentum in the hands of sellers, minimises the chances of an avalanche of additional enquiries and reduces the opportunity for re-negotiation on price.

5. Facing up to COVID Sellers should ensure they can provide full details of visitor policies, infection control policies, infection control grants (including application of the monies) and the financial impact of the pandemic on the business.

The provision of detailed management accounts is a must.

Insurance can be a tricky issue, particularly in an asset sale where insurers may not be willing to sign new business. Both sellers and buyers should work closely with their brokers to try to resolve this, potentially by a transfer of the existing mandate and requesting it to be re-issued in the name of the buyer.

6. Working out the compromise In any negotiations, the parties need to agree how risk will be allocated in order to agree the deal.

This is more relevant than ever in the current climate where there is so much uncertainty, for example, over the adequacy or validity of insurance cover and the risk of complaints and claims from staff and third parties.

Buyers will automatically look for indemnities in the broadest terms to

“Quality information provided at an early stage instils confidence in buyers, investors and lenders.” protect against the unexpected. What is agreed will depend on the bargaining strength of each party. However, in order to keep the deal on track, sellers may need to risk assess the effect of each indemnity and look to negotiate limitations and exclusions rather than give a blanket refusal.

Sellers may also wish to investigate warranty and indemnity insurance to protect from financial losses arising due to unanticipated breaches. This does come with a word of caution – as with all insurance, the impact of COVID-19 has had a significant impact on the cost.

MAKING IT WORK While COVID-19 has had its impact, it is not impossible to successfully sell a care business in the current climate.

Additional considerations do perhaps need to be given to areas that were previously not a focus, but with careful planning, detailed information and a collaborative, open stream of communication, the market is moving, and providers who are faced with wanting or needing to sell are able to do so.

CMM

Hazel Phillips is Partner at Royds Withy King. Email: hazel.phillips@roydswithyking.com Twitter: @ RWK_SocialCare Have you considered selling your business due to the impact of COVID-19? Share your experiences by commenting on this article on the CMM website, www.caremanagementmatters.co.uk 34

CMM December 2020

Enjoy your festive season

Thank you for your continued dedication to adult social care www.caremanagementmatters.co.uk

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CMM December 2020

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Understanding and managing your MENTAL HEALTH

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CMM December 2020

Keeping an eye on your own mental health and that of others around you has always been vital. But with the additional pressures the sector is facing, it’s easy to drop this to the bottom of the list. Marc Caulfield, Chief Executive and Co-Founder at Demolish the Wall, helps us to understand our mental health and how we can ensure we support ourselves and those around us.

When I was asked to write this piece, my first thought went to my late stepfather’s care worker, who told me a hard-hitting story along the lines of this: ‘I was working for a large, well-known care organisation.

They sent me to a client who lived on the other side of London to where I lived, with no offer to compensate or contribute to my increased travel costs. It became apparent that this male client had taken a fancy to me and, after a couple of weeks of being groped and listening to his lewd comments, I discussed the issue with my manager. ‘Deal with it’ was the advice.

‘My professionalism and the client’s clear need for my care led me to continue in this role to the detriment of my mental health, until I had no choice but to the leave the company I was working for.’

Whilst I know this is a sample of one, my research suggests this is not uncommon. The combination of a client in need, uncaring employer and the professional and vocational nature of the care worker delivers a toxic mix. So, as I have become more involved and learnt more about the care industry, I have kept this front-of-mind.

Before I get into the meat of this piece, I feel it is important to

frame it in the context of mental health in general, so here a few eyewatering statistics: • The Royal College of Psychiatrists states, ‘Mental illness is the largest single source of burden of disease in the UK’.

• 676 million people are affected by mental ill health worldwide.

• One in four adults in the UK will experience a mental health issue per year – this figure is the diagnosed number, so the true statistic will be far higher.

• Mental health issues account for 91 million lost working days per year, costing the UK economy £30bn.

THE SCIENCE OF STRESS Front-line care staff are the people who drive business. Their urge, or vocation, to care is a massive positive for businesses for obvious reasons, but as always there is a downside.

Vocational jobs include careers such as care work, nursing and teaching, and people rarely do it for the money – at least not solely.

These careers are about purpose, passion and making a difference.

When your working life is centred around these three tenets, being able to walk away at the end of the working day becomes very difficult.

Let us all be honest here,

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UNDERSTANDING AND MANAGING YOUR MENTAL HEALTH

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if these three tenets are not a solid part of an employee’s mindset, you likely know they will not last long in the role. It is this mindset that makes a great care worker, registered manager or senior manager. But it is also this that leaves one open for consistent and high levels of pressure and stress.

Unless stress is managed, it can, and probably will, develop, becoming anxiety and potentially depression. Managers need to act by the time pressure – a normal feeling that we all need in order to be productive – becomes stress.

Training and support are two main areas that can have positive impacts here. Once someone has moved towards anxiety and depression, the level of help that is required will often be out of the manager’s control and area of expertise. Going back briefly to the vocational aspect of the job, the likelihood is that someone who is driven by purpose, passion and a desire to make a difference will ignore the early warning signs consistent stress is having on their mind, body and performance. This is where managers need to be super involved. The industry must practise what it preaches here and demonstrate care in care.

A word on stress before we move onto the practical steps that can be taken to ensure you are looking after yourself and your staff, and therefore the people you support. Stress is a natural human physiological reaction; it ignites the ‘fight or flight’ response in our bodies allowing us to fight our way out of, or run away from, danger. This response was designed to allow us to escape attack from a sabre-toothed tiger, not to be a constant presence in our normal day-to-day life. In times of stress, the body releases two main hormones; adrenaline and cortisol.

Most people have certainly heard of adrenaline but not so many have heard of or understand cortisol’s role in a stressful

situation. Adrenaline will ebb and flow over time, delivering an increased heart rate and blood pressure and delivering more oxygenated blood to our muscles.

Nothing too scary there. Cortisol delivers the fuel, at all costs, to those muscles, resulting in spikes in blood sugar levels to fuel fight or flight. This is great if you are using this energy boost in fighting or flighting, but not so good if the physical activity is limited, and you are therefore not burning that blood sugar.

Whilst cortisol can deliver heightened memory and attention, which might be helpful in your day-to-day work, the negatives of this hormone outweigh the so-called positives.

It reduces serotonin, the ‘happy’ brain chemical, clearly showing the link between consistent stress and poor mental health. It also suppresses a person’s immune system, leading to more time off sick.

If there is one thing the care industry must act on, it is consistent, unmanageable levels of stress in its people. Senior management, registered managers and care workers all have a duty of care for each other and their clients and their families. This duty of care covers the spectrum of moral, ethical and legal care.

The Mayo Clinic states, ‘Stress symptoms can affect your body, your thoughts and feelings, and your behaviour.

Being able to recognise common stress symptoms can give you a head start on managing them.

Stress that is left unchecked can contribute to many health problems, such as high blood pressure, heart disease, obesity, and diabetes.’ So, what can you do?

STEPS TOWARDS IMPROVEMENT It is clear to see how, as a great senior manager or registered manager, your role can easily

expand into far broader areas than your craft skill. The duty of care mentioned earlier is predominantly centred around the law.

Mental health must be treated the same as physical health. An employee who bravely states they are struggling with a mental health condition should be treated the same as the employee with a cold or broken leg. Indeed, the Equality Act 2010 makes this crystal clear. Care organisations must ensure they have legally robust policies, procedures and training in place to ensure all staff can recognise issues in themselves, and all managers should be trained in spotting the signs in others, as well as themselves.

As managers there are four main areas to focus on: spotting change, talking, listening and acting.

Firstly, you need to learn how to spot the signs of difficulty in your team and/or yourself. You do not need to understand mental health conditions in detail and you certainly do not want to diagnose – this can be a side effect of too much knowledge. You simply need to be able to spot any issues.

The main thing to look for here is change. Changes in behaviour, attitude, appearance or alcohol consumption can all be signs of difficulty. Try to ‘look in the mirror’ or listen to colleagues, family, or friends with regards to yourself.

The idea of putting on your own oxygen mask before helping others is essential here. You will not be able to help others if you do not look after yourself.

Next is learning to talk.

Learning to talk in an open way is not always easy when you are busy. You must ensure you take the time and space to have this conversation. Saying, ‘I am worried you are depressed’ will not work the same way as, ‘I have noticed you are not yourself, is everything OK?’. Sensitivity and compassion are key, so give yourself the time to not rush. You also need

to be prepared for a colleague coming to you, so do not start a conversation you do not have time for.

Listening is by far the hardest part and quite frankly something most of us are not very good at. I always say to remember we have two ears and one mouth, so listen at least twice as much as you speak. It is also is very important to listen non-judgementally. Your opinion on someone else’s mental health is not important. Hearing what they are saying is.

The final area is to act. What should you do now you realise that you or someone you know is struggling? You must remember you are not a therapist; your role is supporting that person, giving them some time off, providing additional resource, having a tricky conversation with a senior manager or client etc. Signposting someone to their GP and/or counselling and therapy services is really where your responsibility should stop. Legal action can be the unfortunate outcome of a clumsy handling of a delicate situation. Sensitivity and training are the name of game here.

TAKING CARE OF EACH OTHER Prevention is always preferable to cure, and managers can do things to prevent mental ill health in their organisations. As a manager ask yourself these questions: Do I actually know my people; what makes them tick; what their personal life is like? Do I know the people they are caring for? Would I recognise them struggling?

If the answers to these questions is negative, then you need to address this urgently. In the eyes of the law, not knowing your people is not an excuse.

Let’s all look out for each other, especially during these incredibly tricky times and continue the hugely important work the highly skilled Care industry does day in day out. CMM

Marc Caulfield is Chief Executive and Co-Founder of Demolish the Wall. Email: marc.caulfield@demolishthewall.com Twitter: @DemolishTheWall How do you support your mental health and that of your staff? Share your knowledge on the CMM website where you can also feed-back on this article, www.caremanagementmatters.co.uk CMM December 2020

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xt? e n e r e Wh

Social care technology trends post-COVID-19 This year has seen rapid adoption of new technologies in social care, but what’s in store for 2021? In this feature, Jonathan Papworth of Person Centred Software shares his thoughts on where he sees regulators and government focusing their attention.

This year will be remembered as the year that COVID-19 hit, and few places were harder hit than social care, with between 15,000 and 25,000 vulnerable people dying in residential care as a result of coronavirus.

No one will know the true figures for mortality.

No one knew the impact of coronavirus on social care until it was too late, and this lack of knowledge and lack of information has been

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WHERE NEXT? SOCIAL CARE TECHNOLOGY TRENDS POST-COVID-19

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recognised by the Secretary of State as being unacceptable. Next year will see a significant focus on fixing the lack of information, with proposals being put to the treasury to fund or part-fund systems needed to enable collation of data from across all care providers.

SHARING OF INFORMATION In 2000, the Freedom of Information Act was passed which created a public ‘right of access’ to information held by public authorities. Access to information is recognised by the government as a basic human right. However, COVID-19 has taken this from many, shutting down family access to their loved ones, and with it the opportunity to fully share their lives.

Edinburgh University is conducting a study on the impact of lockdown. The lead researcher, Dr George Palattiyil, Senior Lecturer of Social Work, says ongoing involvement is a key concern for families once a relative has been admitted to a care home. Humans are social animals, and nothing fully replaces direct human interaction, but there are many things that can help. Video conferencing has been a massive saviour for many, with families able to interact virtually, but video conferencing doesn’t replace everything.

Visiting a loved one gives insight into not just how the person is at the time, but also the care they receive and the environment they live in.

Some of this information can be replaced by having access to information about the care that’s been provided. Social care providers are regulated on the documented quality of evidence about the care they provide and the care needs of the individual.

This information has been created and maintained, and yet most care providers don’t share this information with anyone. There has been a historical fear of others having access to this information, but logically fears should only arise if the quality of the care or the quality of the documentation is substandard. If it is the quality of care, then the family has a vested interest in knowing this. If it is the quality of documentation, then the regulator will rate the care provider poorly. So, no one really has a vested interest in hiding this information from family members other than care providers who have something to hide. There is a logical connection between quality of care and transparency of information, and this connection will hopefully become increasingly recognised.

This all leads to one obvious conclusion, and that is that care providers will, over the course of the next few years, be adopting information systems that provide the data that government needs to fight this and any future pandemic, and gives assurance to family members that their loved ones are being properly cared for.

2021 will be the year, I believe, that paper-based systems will be recognised by government and regulators as not adequate for the standard of care this country expects. About 30% of care providers 42

CMM December 2020

have already adopted digital care systems and these are the enablers for collating information and disseminating that information to those who have rights to it. During 2021, I would be surprised if this doesn’t increase to more than 50%, by which time it will become an expected component of social care in the same way that nurse call systems have become in residential care, and smoke alarms in support living environments.

DELIVERING BENEFITS Whilst there are literally hundreds of case studies and CQC reports highlighting the benefits of digital systems, there remains a reluctance for some care providers to take the step away from their beloved paper systems.

One case that might help focus attention is of a care home on the Isle of Skye that became the centre of media attention due to an outbreak of COVID-19 and the devastating effect this had on residents and care workers (https://www.bbc.co.uk/ news/uk-scotland-highlands-islands-54013830).

The care home has agreed to be taken over by NHS Highland, who have over a dozen care homes already that all use a digital clinical care system. The person who has been asked to manage the home has demanded that a digital clinical care system is implemented as part of them taking over managing the home. Such is the benefit of digital care technology that people who have understood the benefits simply will not accept reverting to paperbased systems.

The great advantage of a digital platform, beyond the direct benefits in efficiency and transparency, is that the data they collect can be used in new and innovative ways.

One of the key trends that is underway, but will likely accelerate over the next 12 months, is interoperability between healthcare and social

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Professor Trish Hafford-Letchfield from Middlesex University shares latest research and best practice in supporting people to be open about their identities in care.

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It is safe to say that working positively and inclusively with people who have diverse sexual and gender identities can be a very challenging area for social care, yet numerous research studies have shown that this remains a peripheral issue for the workforce.

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This is despite evidence showing that the LGBT+ community experiences higher incidence of mental health issues, such as anxiety and depression, suicide and problematic substance use, and that their general health can be worse than that of heterosexual or cisgendered people. Additionally, findings from research with LGBT+ adults indicate that they lack confidence in care services, causing a reluctance or delay in seeking help.

This is primarily a result of people’s previous experiences of discrimination, but is also down to a continuing lack of clear direction in working with members of the LGBT+ community, and a distinct absence of targeted policies and practice guidance. Opportunities have been made to remedy this within generic policies impacting on care (such as in mental health, dementia and ageing), but they have so far been disappointing and have only paid cursory attention to the LGBT+ community’s specific needs and circumstances.

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As well as this, people could face discrimination, or fear facing discrimination, in services such as care homes and supported housing, where other residents might be intolerant of living with LGBT+ people who are open about their sexuality and gender identities. These fears must be seen in the context of the enormous disparities and inequalities that LGBT+ people face.

from the ground up

There is also an issue in the idea that some professionals and care workers might operate from the presumption that all people identify as heterosexual or cisnormative (meaning that we see people with a fixed stereotyped gender).

Whether or not this is true for a social care professional, the idea itself makes it very difficult for people using services, and their carers, to talk openly about their lives and relationships.

The scope of the issue In 2018, Government commissioned a national survey with over 108,000 LGBT+ respondents to find out more about the prejudices they are facing. Some of the findings make for difficult reading in light of perceived progress – LGBT+ people reported being less satisfied with their life than the general UK population, with particularly low scores for transgender respondents.

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More than two thirds of LGBT+ respondents said they still avoided holding hands with a same-sex partner for fear of a negative reaction from others.

Verbal harassment or physical violence is an ever-present experience which was significantly underreported, and ‘conversion’ or ‘reparative’ therapy offered to ‘cure’ people with different identities is still present in UK society. This all feeds in to how people will feel about being open about their sexual and gender identities in later

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facing up to a rising need

Better domiciliary care

is it just me...?

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CMM December 2020

43

OVER 2.1 MILLION ISSUED IN GRANTS DURING 2020 SO FAR TO CARE WORKERS IN NEED! Knowing someone is there to help can be just the lifeline needed.

This is why we will never stop.

We are now raising funds for our new Mental Health Grants appeal.

Research shows that the mental health of care and support workers was suffering before the coronavirus existed. Since then, social care workers have experienced challenges that most of us cannot even imagine. The toll on mental health is massive.

THIS IS WHY THE CARE WORKERSâ&#x20AC;&#x2122; CHARITY IS WORKING ON CREATING A MENTAL HEALTH GRANT STREAM AND WE NEED YOUR HELP TO RAISE FUNDS FOR IT.

HELP US, PLEASE DONATE TO MAKE A DIFFERENCE TODAY.

https://thecareworkerscharity.enthuse.com/cf/mental-health-appeal Anyone looking to learn more why not book an information session about the work we do and the grants available. Email to book your session here info@thecwc.org.uk 44

CMM December 2020

WHERE NEXT? SOCIAL CARE TECHNOLOGY TRENDS POST-COVID-19

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care. There are some obstacles to making healthcare data available to social care in terms of information governance, but use of the NHS Data and Security Protection (DSP) Toolkit is being encouraged to help overcome this. Passing this self-assessment allows providers access to NHS Mail, and a lower ‘entry level’ threshold has been negotiated for social care, but this lower threshold is temporary and is due to expire at the end of December 2020.

Irrespective of the challenges, the benefits of joining up information held in social care with that held in healthcare will help improve outcomes as individuals transition between care settings. It is likely that the core issues of information governance will be identified and resolutions worked on in the foreseeable future, and once this has been achieved then there is likely to be an increasing need for social care to embrace digital systems or they will risk being left out in the cold.

COLLECTING THE DATA A second key trend for next year will be automated data collection. Historically, all evidence of care was done manually, with people writing down a person’s weight, temperature, or blood pressure – using a

“As social care providers increasingly embrace digital technology to capture evidence of care and individuals' care needs, so the opportunities for automated analysis of trends will improve.” measurement device, but writing the answer into the evidence of care system. However, new technology is emerging that can automatically highlight and/or record issues.

We are already seeing acoustic monitoring systems that can automatically identify certain symptoms, such as a cough that indicates COVID19. There are products currently available that will periodically take a person’s vital measurements, and these are widely used in the consumer sector with devices such as Fitbit and step counters. There are

wearable devices that detect if someone has had a fall, or if their continence pad needs changing.

These devices are only going to get more accurate and will become increasingly widely used. Periodic night-time checks on a person’s wellbeing that interrupt their sleep patterns and risk leaving them unattended between checks will become a thing of the past eventually, and the rate of development of new devices is only going to increase in the coming years.

ARTIFICIAL INTELLIGENCE One final trend that is starting to arrive is automated machine learning based on the recent evidence of care. There are already artificial intelligence (AI) based tools that help to identify the level of pain a person is experiencing, and this has been shown to reduce over-medication. A study by University College London has found technology that’s been able to predict, with 87% accuracy, a person likely to suffer a fall in the next two weeks.

As social care providers increasingly embrace digital technology to capture evidence of care and individuals' care needs, so the opportunities for automated analysis of trends will improve.

The perception that care staff have of a person’s changing care needs will become supported by evidence and insights not readily available historically.

Some of these principles are already being trialled for complex behavioural issues in young people with learning disabilities, where the combination of events that trigger an episode of challenging behaviour are not immediately obvious. Without analysing vast quantities of information, something impractical to do at a human level, the combination of events is hard to trace, however it is not only more possible, but immensely more cost-effective, at a computer level.

There is one trend that I hope will not become widely established, and that is for robotic care.

There are several studies showing that people with dementia can interact with robotic devices that have been trained to respond to people verbally. This does entertain people and, given advanced dementia, when a person will often repeat themselves regularly, there is an obvious benefit against either a care worker being tied up for little benefit or a person being left alone with no interaction.

There has been no long-term study yet, but the Edinburgh University study is showing that people need interaction with people, and whilst robots will get cleverer and will have some use in care settings, I personally do not believe that there is any substitute for human interaction, and the amazing work that care workers do is simply irreplaceable.

CMM

Jonathan Papworth is Co-Founder and Director of Person Centred Software.

Email: hello@personcentredsoftware.com Twitter: @PersonCentredSW What are your predictions for the next year in social care technology? Share your thoughts and leave feedback on this feature on the CMM website, www.caremanagementmatters.co.uk CMM December 2020

45

CELEBRATING EXCELLENCE:

Markel 3rd Sector Care Awards

MARKEL 3RD SECTOR CARE AWARDS

The finalists in the Markel 3rd Sector Care Awards have been announced and have now faced the expert judging panel.

COVID-19 might have postponed face-to-face events across the UK, but the Markel 3rd Sector Care Awards remain as committed as ever to celebrating the outstanding innovation and creativity in the voluntary care and support sector.

The sector has had to go further this year than any other, not only to keep groups and services running, but also to keep people safe.

We are pleased to say that from what we have seen, it has more than risen to the challenges hurled at it this year, and some excellent examples of extraordinary work have been shared with us.

This hard work and dedication must be recognised and championed.

THE FINALISTS

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Innovative Quality Outcomes Award • The Hospice Heart Partnership Project.

• The Care Workers' Charity.

• Music as Therapy International.

Contribution to Sector Development Award • St Luke's Hospice, Harrow and Brent.

• Evergreen Care Trust.

• FutureRoots.

Community Engagement Award • MCR Pathways.

• Barnsley Dementia Gateway Service.

• Intergenerational Music Making.

Creative Arts Award • Intergenerational Music Making.

• Head2Head Sensory Theatre.

• Demelza, Hospice Care for Children.

Every year, it is a challenge for our judges to narrow down the finalists in each category, and 2020 was no different. A high calibre of entries from organisations large and small showed all the ways people had gone above and beyond in caring for the people they support.

The 2020 Markel 3rd Sector Care Awards finalists are:

Campaigning for Change Award • Intergenerational Music Making – Care to Create.

• Aspens Charities, #CareForTheCarers Campaign.

Compassion Award • Gladys Nkhola, Monet Lodge.

• Intergenerational Music Making.

• Sara Costa, Outlook Care.

Technology Award • Support 4 Independence.

• Digitisers - Surrey Choices.

• ENABLE Me.

CMM December 2020

Leadership Award • Paul Bott, SJOG. • Sara Costa, Outlook Care.

• Karolina Gerlich, Executive Director, The Care Workers' Charity.

MARKEL

3RD SECTOR CARE AWARDS

Making a Difference Award • Kaye Wright, Chair, Friends of Dorset Care Leavers.

• Karolina Gerlich, Executive Director, The Care Workers' Charity.

• Piotr Rejek, Chief Executive, Outlook Care.

Dementia Care Award • Music for Dementia.

• Retain Wellbeing CIC - GIFT Café.

• Alzheimer’s Support.

End of Life Care Award • St Lukes Hospice, Harrow and Brent.

• Martin House Hospice Care for Children and Young People.

• Sherdley Court.

Collaboration (Integration) Award • Options for Supported Living.

• The Independent Living Roadshow.

• Intergenerational Music Making – #musicalconversations.

THE JUDGING DAY

THE CEREMONY

Our judging day is an integral part of the Markel 3rd Sector Care Awards. It’s an opportunity for our finalists to speak to the judging panel about their projects, ambitions and histories and offer more context to their entries. Judges delve deeper into the real values behind each organisation and attempt to narrow each category down to one winner.

This year, our usual panel of leaders, peers, and experts listened to outside-the-box thinking, creativity, and stories of compassion.

The day took place virtually, allowing the judges to ‘meet’ and interview finalists across all 12 categories.

The judging day never fails to bring with it a rollercoaster of emotion as we hear about all the immensely impressive ways that staff and volunteers are affecting people’s lives. The panel was astounded but not surprised by the quality of finalists for this year's awards, with innovation around handling the challenges that 2020 has thrown at services in all aspects of care.

While technology has provided so many people much-needed support during this year, and virtual meetings, conversations, and judging have become the norm, we are hopeful that this can remain a face-to-face event.

As it usually takes place in December, we have pushed the date into the New Year, and will keep everyone informed of the date that is decided on. Whether it goes ahead face-to-face or unavoidably has to be virtual, we hope you will be part of the 2021 event. We are delighted to once again have Markel on board, which, along with the support of our other sponsors, helps to keep this highly-regarded event free for finalists to attend and to enter.

CMM To keep up to date with all the latest on the event, including a newly proposed date for 2021, and to see more about the Markel 3rd Sector Care Awards finalists 2020, follow @3rdsectorcare on Twitter and keep an eye out for #3rdSectorCareAwards.

Headline Sponsor

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The Markel 3rd Sector Care Awards is run specifically for the voluntary care and support sector. www.3rdsectorcareawards.co.uk.

Sponsorship opportunities are available.

Contact David Werthmann on david.werthmann@carechoices.co.uk or 01223 206955.

With thanks to our supporters: National Care Forum, Learning Disability England, The Care Provider Alliance, Association of Mental Health Providers and VODG. CMM December 2020

47

EVENT REVIEW

SOCIAL CARE FUTURE: TOWARDS A BRIGHTER FUTURE 4th-6th November 2020

At the beginning of November, Social Care Future laid on a multitude of presentations, debates, interviews and conversations, all targeted towards sharing and engaging in ideas and aspirations for the future of social care.

The three-day online festival brought together industry leaders, local not-for-profit care providers and those receiving care and support to express their collective goals and ambitions, comprising innovation, inclusivity and above all, reform.

hot topic of discussion, and a panel of experts delved into their individual experiences of the coronavirus pandemic, particularly around how their local communities had come together to support those who are most vulnerable. The theme of this presentation was exploring the long-term potential of the mutual aid system as a means of delivering care beyond COVID-19 and its potential relationship with pre-existing state services.

GROWING RELATIONSHIPS

COLLABORATION AND WORKFORCE

The themes of both growing and maintaining strong community relationships as a means of positively influencing the future of social was one that underpinned the festival. On the first day, presentations from Grapevine – a charity supporting people with learning disabilities in Coventry and Warwickshire – and a panel of experts from Manchester and the surrounding areas, discussed the crucial role that showing kindness and togetherness plays in maintaining wellbeing, irrespective of the care setting.

Grapvine highlighted how it aims to empower and strengthen the people it works with, spark community action and shift power within the individuals it works with, as well as the services that support them.

It was inevitable that COVID-19 would be a

Day two of the festival featured discussion points such as the role of not-for-profit care providers and of social care workers. The first presentation of the day came from an informal provider collaborative, comprising Certitude Support, Camphill Village Trust, Macintyre, Choice Support and United Response. The presentation was chaired by Aisling Duffy, Chief Executive of Certitude Support, who delivered a mission statement on behalf of the collaborative. The statement aligned the collaborative firmly alongside the ambitions of Social Care Future, whilst acknowledging that the not-for-profit sector can do more to deliver flexible and outcome-motivated services to those that it supports.

The social care workforce is an indisputable

element of social care’s future and day two of the festival gathered together expert speakers from organisations including The Freemantle Trust, Carers Trust Heart of England and Skills for Care to dissect exactly what it will mean to work in social care in the future. The presentation primarily aimed to explore the challenges associated with changing people’s attitudes towards the social care workforce for the better. Following this, those in attendance were encouraged to break out and discuss their ideas for potential new roles that could lead to a reinvigorated social care workforce.

The final day of the Towards a Brighter Future festival certainly focused on the buzzword of the event, the ‘future’. A key highlight from the final day included the delivery of some initial research findings regarding the general public’s attitude towards social care. This presentation was hosted by Clenton Farquharson MBE, Chair of Think Local Act Personal. He summarised that the language, terminology and other means of communication used in the day-to-day running of the sector are not being used to their full potential, suggesting we need a shift towards more positive manifestations if social care is to experience the brighter future it strives to achieve.

For access to the recorded presentations, visit the Social Care Future website.

Look out for announcements about

CMM Insight events happening in 2021

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CMM December 2020

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MARKEL 3RD SECTOR CARE AWARDS

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CMM December 2020

49

CAROLINE WATERS OBE • INTERIM CHAIR • EQUALITY AND HUMAN RIGHTS COMMISSION

Caroline Waters OBE of the Equality and Human Rights Commission explains why now more than ever is the time for us to show we care about those living in care.

As the nights draw in and the number of COVID-19 positive tests seems to be ticking ever upwards, I don’t think many of us doubt that we are in for a long and challenging winter. That’s why we need to urgently take action to safeguard the rights of people who live in residential care.

Many of the decisions in the coronavirus response raise serious questions about the value we place on older and disabled people’s lives.

Older and disabled people were known to be at high-risk from COVID-19 but the ‘protective ring’ around care homes doesn’t seem to have delivered for them. People who live in these settings have felt the impact of the pandemic in every aspect of their daily lives. I don’t think it’s a stretch to say that the way in which we treat these individuals is an indication of how compassionate and progressive our

society is, and this is especially true in times of crisis.

We can act now to demonstrate how much we value the lives of care home residents. We have recently shared detailed briefings on Equality and human rights in residential care in England and Wales during coronavirus, which are being published alongside our snapshot report into How coronavirus has affected equality and human rights in Britain.

These can be accessed from the Equality and Human Rights Commission website.

We are asking national and local governments, regulators and care providers to ensure that equality and human rights laws are at the heart of decision-making. These laws set out obligations to protect people’s lives, dignity, wellbeing and freedoms, and in the current situation, they are more vital than ever. In challenging times when difficult decisions must be made, human rights laws are an essential and helpful framework to guide difficult decisions and protect those we care about.

So, what does this mean? Well, it means that policies that may have an uneven impact on people with a protected characteristic (like old age or disability) must involve a careful assessment and mitigation of this impact. I’m concerned to hear that there is scant evidence to show how the response to COVID-19 relating to care home residents was agreed and whether the equality and human rights impact was considered. Local and national governments must consider the impact of their decisions in the COVID-19 response on care home residents with different protected characteristics and be in a position to demonstrate how they have done this.

Blanket bans on visits from loved ones need to be replaced by individual risk assessments which consider the full range of human rights of care home residents and treat people like the individuals they are.

‘Do not attempt resuscitation’ orders which may have been issued en-masse in the Spring need to be urgently revisited,

Caroline Waters OBE is Interim Chair of the Equality and Human Rights Commission.

Email: socialcare@equalityhumanrights.com Twitter: @EHRCChair 50

CMM December 2020

discussed with residents or their family members and, if appropriate, removed from files. Whilst the NHS was severely stretched in the early days of the pandemic, decisions on withholding access to medical treatment must not violate people’s right to life and to be free from ill treatment. These rights cannot be limited or suspended, even in times of national emergency.

We are all living with restrictions, but in care homes some people have been effectively confined to their rooms and the effects of isolation are really serious. Wider reductions in support might mean more people move into care homes when they could live in their own homes and communities with the right support. Ultimately, the right to live independently, as enshrined in the UN Convention on the Rights of People with Disabilities, needs to be incorporated into our domestic laws to properly maintain standards and protections for disabled people.

The Prime Minister committed on 15th July to an independent inquiry into the response to coronavirus ‘in the future’. Months later, we still don’t have an inquiry underway and time is ticking. The Equality and Human Rights Commission has asked the UK Government to urgently undertake or commission a review into deaths in care homes during the pandemic, so that loved ones of those who were lost have answers and lessons can be learned.

The Government has made positive steps to support the social care sector, with more testing capacity and PPE, and revised guidance on visits. But care home staff have continued to report difficulties on the ground. We face uncertain times ahead and it’s crucial we act now to protect older and disabled people and those who work hard providing care.

Disabled and older people who live in residential care matter; they must be treated with dignity and respect, and their human rights must be upheld. I know we do value the lives of older and disabled people in this country. Now is the time for us to show it.

CMM

The National Care Forum (NCF) COVID-19 resources – for members and non-members.

Make sure you are aware of all the latest guidance, thinking and intelligence in response to the fast changing situation with COVID-19 Visit the NCF website: www.nationalcareforum.org.uk

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• The latest from PHE, DHSC & NHS England • PPE guidance, Infection Prevention & Control • Hospital Discharge, Critical Care guidance & Commissioning • Information Governance & using Technology & Data • Regulation & Legal – Care Act easments, DoLS & DBS • Workforce - Terms & Conditions & Recruitment • Supported Housing & Homeless • Wellbeing • Volunteering • Practical Activity Resources

EMB ERS TW NE T • HIP • NOT FOR PROFI

NCF members benefit from: • Weekly Zoom Calls and Regular Briefings • NCF is also working closely with CPA & other members of the All-Party Parliamentary Group on Adult Social Care (APPG) to influence parliamentarians • #HereToCare Campaign - NCF is ensuring the amazing work happening in the sector is being recognised at national & local government and in the media

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NCF innovations: • The Hubble Project: digital innovation hubs offering care providers the chance to learn how other have introduced, used and evaluated a range of digital technology to improve care • IPC Compliance Assessment Tool – developed using the most recent information from CQC and others • Covid-19 Checklist to help people navigate care home choices during the pandemic Get in Touch & ask about receiving our Regular Mailings – we want as many providers to be informed as possible

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NCF is the leading voice for not-for-profit care providers

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www.nationalcareforum.org.uk @NCFCareForum info@nationalcareforum.org.uk 02475 185 524

NCF works directly with not for profit care & support providers across the UK supporting members to improve social care provision & enhance the quality of life, choice, control & well-being of people who use care services.

Practical advice and cost savings for care providers Representation

• Representing the sector in Parliament and Whitehall • Connecting care providers with politicians at a national and local level • Opportunity to express members’ views to the Government, senior MPs and the DHSC and other government departments help to shape strategy and policy

Policy

• Responding to national consultations • Representing the sector in national policy development and implementation groups • Delivering up to date briefings on policy developments

Information

• Regular information and policy update emails, a monthly newsletter (Care Agenda), a parliamentary wrap up email, events, webinars • Daily press cuttings service highlighting the key stories of the day • Daily Policy update email • Weekly Wrap-Up email • Delivering for You: An annual summary of the work carried out by Care England during the year

Giving you more

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